Anticoagulant-induced intramural intestinal hematoma

Polat, Cafer; Dervişoğlu, Adem; Güven, Hakan; Kaya, Ekrem; Malazgirt, Zafer; Danacı, Murat; Özkan, Kayhan

doi:10.1016/s0735-6757(02)42258-9

Cited by 81 publications

(114 citation statements)

References 7 publications

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“…For AMI, the rate of PI in CT reports in previous studies was approximately 26.7-60% (17, 21) and 39.6% in our study. For SIIH, PI was not found in the CT reports in previous studies (1,3,5,7,14,15) or in our study. Although SIIH had a significantly lower rate of PI as compared with AMI (p<0.001), we could not analyze the odds ratio of PI since it was 0% in SIIH patients.…”

Section: Discussioncontrasting

confidence: 76%

“…Unfortunately, abdominal CT occasionally does not help EPs differentiate SIIH from AMI due to similar CT findings (4)(5)(6). It is critical for EPs to make the right decision because the optimal treatments are quite different, conservative medical treatment for SIIH (1,7,8) and emergent surgical intervention for AMI (9)(10)(11). In our study, 20% (6/30) of the SIIH patients were transferred to our hospital under the impression of AMI and for emergent surgical intervention.…”

Section: Discussionmentioning

confidence: 80%

“…Patients typically complain of abdomen pain (100%) (1,2), and the rate of peritonitis is approximately 7.7-61.5% (1)(2)(3). Emergency physicians (EPs) must exclude the possibility of surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

“…However, abdominal CT occasionally is not useful to help EPs differentiate SIIH from acute mesenteric ischemia (AMI) due to similar findings, such as homogenous bowel wall thickening or the presence of a target sign on intravenous contrast-enhanced studies (4)(5)(6). Ap- (1,3,7,8) and emergent surgical intervention for AMI (9)(10)(11). The purpose of our study was to discern the differences in abdominal CT findings and help EPs to differentiate SIIH from AMI.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Intramural Intestinal Hemorrhage versus Acute Mesenteric Ischemia by CT Evaluation

et al. 2016

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Objective The purpose of our study was to differentiate the imaging findings of patients with spontaneous intramural intestinal hemorrhage (SIIH) from those with acute mesenteric ischemia (AMI) after abdominal computed tomography (CT) survey in the emergency department. Methods We retrospectively included 83 patients diagnosed with SIIH or AMI after abdominal CT. Results The mean ages of 30 SIIH patients and 53 AMI patients were 74.4±14.6 years and 75.8±11.2 years, respectively. Patients with SIIH had significantly thicker maximal intestinal wall thickening (14.8±3.9 vs. 10.9 ±4.1, p<0.001), a lower rate of ileum involvement (26.7% vs. 77.4%, p<0.001) and a higher rate of ascites (96.7% vs. 64.2%, p<0.001) compared with patients with AMI. Neither pneumatosis intestinalis (p< 0.001) nor portomesenteric gas (p<0.01) were detected in SIIH patients but were observed in AMI patients. A receiver-operating characteristic (ROC) curve analysis showed that the optimal cut-off value for maximal intestinal wall thickening between groups was 10.4 mm and the area under the ROC curve between groups was 0.752 (p<0.0001). A multiple logistic regression analysis showed that the independent predictors of SIIH were non-involvement of the ileum (odds ratio, OR, 6.998; p=0.001), maximal intestinal wall thickening ! 10.4 mm (OR, 5.748; p=0.040) and ascites (OR, 13.348; p=0.023). The area under the ROC curve for the model was 0.854 (p<0.001). Conclusion The independent predictors of SIIH from AMI after abdominal CT in acute abdominal patients include non-involvement of the ileum, intestinal wall thickening ! 10.4 mm, and ascites.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spontaneous Intramural Intestinal Hemorrhage versus Acute Mesenteric Ischemia by CT Evaluation

et al. 2016

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“…The combination of CT and US can show the exact pathology in all patients, as demonstrated by some authors [17].…”

Section: Imaging Findingsmentioning

confidence: 82%

Spontaneous intramural small-bowel hematoma secondary to anticoagulant therapy: a case series

Samie

Sun

Huber

et al. 2012

Med Klin Intensivmed Notfmed

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ダビガトラン内服中に生じた広範囲結腸粘膜下出血により結腸亜全摘を余儀なくされた1例(A case of subtotal colectomy caused by dabigatran–associated extensive intramural hemorrhage of the colon)

Moriyama)¹,

美樹²,

太郎³

et al. 2019

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨直接経口抗凝固薬内服中に広範囲結腸粘膜下出血を生じ結腸亜全摘を要した症例を経験した。症例は81歳の女性で非弁膜症性心房細動に対しダビガトランを内服していた。臍周囲間歇痛と嘔吐で発症し，約5時間後にショックとなり搬送された。搬入時，PT–INRが4.52，APTTは測定不能と高度の凝固異常があったが，腎機能は正常であった。汎発性腹膜炎と診断し緊急開腹術を施行したが，凝固障害のため，結腸亜全摘術後の出血部にガーゼパッキングを行いopen abdomen managementとした。ダビガトランの作用が消失するまでの72時間にわたり凝固障害が持続し，出血制御に難渋した。ダビガトラン特異的中和剤であるイダルシズマブの認可前であったため，凝固異常に対し大量輸血で対処せざるを得なかった。72時間以降，凝固能は急速に改善し，第44病日に軽快転院となった。病理組織検査では，結腸のほぼ全域に粘膜下出血と，粘膜固有層から筋板下までの出血凝固壊死がみられた。経口抗凝固薬の消化器系合併症には消化管出血以外に壁内血腫の報告が散見される。その多くは限局性で保存治療によって軽快するが，本症例のように広範囲粘膜下出血より粘膜固有層・筋板下までの出血凝固壊死を生じて腸管切除を要した症例は極めてまれである。治療は凝固因子補充が主体だが，新たにイダルシズマブが認可されたため，今後はイダルシズマブが治療の第一選択となり得る。

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Anticoagulant-induced intramural intestinal hematoma

Cited by 81 publications

References 7 publications

Spontaneous Intramural Intestinal Hemorrhage versus Acute Mesenteric Ischemia by CT Evaluation

Spontaneous Intramural Intestinal Hemorrhage versus Acute Mesenteric Ischemia by CT Evaluation

Spontaneous intramural small-bowel hematoma secondary to anticoagulant therapy: a case series

ダビガトラン内服中に生じた広範囲結腸粘膜下出血により結腸亜全摘を余儀なくされた1例(A case of subtotal colectomy caused by dabigatran–associated extensive intramural hemorrhage of the colon)

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